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Oosten JD, DiBartola AC, Wright JC, Cavendish PA, Milliron EM, Magnussen RA, Duerr RA, Kaeding CC, Flanigan DC. More Is Not Merrier: Increasing Numbers of All-Inside Implants Do Not Correlate with Higher Odds of Revision Surgery. J Knee Surg 2024; 37:361-367. [PMID: 37336501 DOI: 10.1055/a-2112-8158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The purpose of this study was to evaluate the relationship between the number of all-inside meniscal repair implants placed and the risk of repair failure. We hypothesized that the use of higher numbers of all-inside meniscus repair implants would be associated with increased failure risk. A retrospective chart review identified 351 patients who underwent all-inside meniscus repair between 2006 and 2013 by a sports medicine fellowship-trained orthopaedic surgeon at a single institution. Patient demographics (age, body mass index [BMI], sex) and surgical data (number of implants used, concomitant anterior cruciate ligament reconstruction [cACLR], and tear type/size/location) were recorded. Patients who received repairs in both menisci or who had follow-up < 1-year postoperatively were excluded. Repair failure was identified through chart review or patient interviews defined as a revision surgery on the index knee such as partial meniscectomy, total knee arthroplasty, meniscus transplant, or repeat repair. Logistic regression modeling was utilized to evaluate the relationship between the number of implants used and repair failure. A total of 227 all-inside meniscus repairs were included with a mean follow-up of 5.0 ± 3.0 years following surgery. Repair failure was noted in 68 knees (30.3%)-in 28.1% of knees with fewer than four implants and in 35.8% of knees with four or more implants (p = 0.31). No significant increase in failure was observed with increasing number of all-inside medial (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.79-1.7; p = 0.46) or lateral (OR: 0.86; 95% CI: 0.47-1.57; p = 0.63) implants after controlling for patient age, BMI, cACLR, tear type, or size. Tears of the lateral meniscus located in the red-white and white-white zones had lower odds of failure (OR: 0.14; 95% CI: 0.02-0.88; p = 0.036) than tears within the red-red zone, and patients with cACLR had lower odds of repair failure (OR: 0.40; 95% CI: 0.18-0.86, p = 0.024) than those without. The number of all-inside implants placed during meniscus tear repair did not affect the likelihood of repair failure leading to reoperation after controlling for BMI, age, tear type, size, location, and cACLR. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- James D Oosten
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jonathan C Wright
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Parker A Cavendish
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Eric M Milliron
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Duerr
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Schweizer C, Hanreich C, Tscholl PM, Blatter S, Windhager R, Waldstein W. Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure. Am J Sports Med 2024; 52:822-831. [PMID: 37022676 DOI: 10.1177/03635465231158385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. PURPOSE This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. RESULTS The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). CONCLUSION This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Carola Hanreich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe M Tscholl
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health
| | - Samuel Blatter
- Division of Orthopedics and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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Kahan JB, Burroughs P, Petit L, Schneble CA, Joo P, Moran J, Modrak M, Mclaughlin W, Nasreddine A, Grauer JN, Medvecky MJ. Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction. PLoS One 2023; 18:e0294964. [PMID: 38015977 PMCID: PMC10684064 DOI: 10.1371/journal.pone.0294964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). METHODS Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. RESULTS In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). CONCLUSION The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.
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Affiliation(s)
- Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Logan Petit
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Peter Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - William Mclaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Adam Nasreddine
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
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Migliorini F, Asparago G, Oliva F, Bell A, Hildebrand F, Maffulli N. Greater rate of return to play and re-injury following all-inside meniscal repair compared to the inside-out technique: a systematic review. Arch Orthop Trauma Surg 2023; 143:6273-6282. [PMID: 37284879 PMCID: PMC10491517 DOI: 10.1007/s00402-023-04933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Inside-out and all-inside arthroscopic meniscal repairs are widely performed. However, it remains unclear which method promotes greater clinical outcomes. This study compared inside-out versus all-inside arthroscopic meniscal repair in terms of patient-reported outcome measures (PROMs), failures, return to play, and symptoms. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. Two authors independently performed the literature search by accessing the following databases: PubMed, Google Scholar, and Scopus in February 2023. All clinical studies which investigated the outcomes of all-inside and/or inside-out meniscal repair were considered. RESULTS Data from 39 studies (1848 patients) were retrieved. The mean follow-up was 36.8 (9 to 120) months. The mean age of the patients was 25.8 ± 7.9 years. 28% (521 of 1848 patients) were women. No difference was found in PROMs: Tegner Activity Scale (P = 0.4), Lysholm score (P = 0.2), and International Knee Document Committee score (P = 0.4) among patients undergoing meniscal repair with all inside or inside-out techniques. All-inside repairs showed a greater rate of re-injury (P = 0.009) but also a greater rate of return to play at the pre-injury level (P = 0.0001). No difference was found in failures (P = 0.7), chronic pain (P = 0.05), reoperation (P = 0.1) between the two techniques. No difference was found in the rate of return to play (P = 0.5) and to daily activities (P = 0.1) between the two techniques. CONCLUSION Arthroscopic all-inside meniscal repair may be of special interest in patients with a particular interest in a fast return to sport, while, for less demanding patients, the inside-out suture technique may be recommended. High-quality comparative trials are required to validate these results in a clinical setting. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany.
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke On Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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Kim SH, Min K, Kim KI, Lee SH. Clinical and MRI Outcomes of Repaired Peripheral Longitudinal Tears of the Posterior Horn of the Medial Meniscus With ACL Reconstruction: Results According to Tear Size. Orthop J Sports Med 2023; 11:23259671231167535. [PMID: 37655242 PMCID: PMC10467388 DOI: 10.1177/23259671231167535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Arthroscopic repair of longitudinal tears in the medial meniscal posterior horn (MMPH) has been reported to result in high rates of meniscal healing when performed alongside anterior cruciate ligament reconstruction (ACLR). However, studies that have focused on longitudinal tears and their impact on clinical outcomes after arthroscopic repair are insufficient. Purpose To investigate the clinical outcome and healing status after concomitant arthroscopic ACLR and repair of MMPH peripheral longitudinal tears, with respect to the tear length. Study Design Cohort study; Level of evidence, 3. Methods A total of 263 patients who underwent concurrent arthroscopic suture repair of longitudinal tears of the MMPH and ACLR were enrolled. All patients had 2-year postoperative magnetic resonance imaging (MRI) evaluations, and 61% of patients underwent a second-look arthroscopy. The exclusion criteria were partial meniscectomies and multiligament injuries. Patients were assessed pre- and postoperatively for clinical scores, amount of anterior translation, grade of pivot shift, and presence of meniscal tear extension. According to the length of longitudinal tears, patients were classified into 2 groups: (1) patients with tears that were located in the posterior compartment and (2) patients with tears that extended to the midbody of the meniscus. Binary stepwise logistic regression analysis was used to evaluate the risk factors for unhealed menisci as identified by MRI. Results A total of 83 patients were included in this study-52 patients (group 1) had MMPH tears without tear extension and 31 patients (group 2) had MMPH tears with tear extension. There were no differences in outcomes between the groups, including the healing rate after meniscal repair (P > .05). Based on postoperative MRI scans, 67 patients (80.7%) were categorized as completely healed and 16 patients (19.3%) as unhealed. There were no significant differences between the completely healed and unhealed groups in outcomes or the rate of preoperative midbody tear extension. Higher body mass index and lower preoperative Lysholm scores were identified as risk factors for unhealed menisci. Conclusion Overall, the rate of complete healing of MMPH tears repaired concomitantly with ACLR was 80.7% (67/83), and midbody tear extension did not affect the healing rate of the repaired meniscus. Results indicate that suture repair for unstable MMPH tears should be considered regardless of tear size.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyeonguk Min
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Avila A, Rao N, Buzin S, Shankar DS, Davidson P, Strauss EJ. Arthroscopic Meniscus Repair Using an All-Inside, All-Suture, Knotless Device. Arthrosc Tech 2023; 12:e615-e619. [PMID: 37323774 PMCID: PMC10265270 DOI: 10.1016/j.eats.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023] Open
Abstract
With an increased appreciation of the importance an intact meniscus has on normal knee kinematics and function, more meniscal tears are being treated with a repair rather than partial meniscectomy. There are several techniques for repairing torn meniscal tissue, including the outside-in, inside-out, and all-inside repairs. Each technique comes with its advantages and drawbacks. The inside-out and outside-in techniques allow for greater control of the repair using knots outside the joint capsule; however, they pose a risk for neurovascular injury and require additional incisions. Arthroscopic all-inside repairs have seen increasing popularity, but with current techniques, fixation is achieved either with intra-articular knots or extra-articular implants, leading to variable outcomes and the potential for postoperative complications. This technical note describes the use of SuperBall, an all-inside meniscus repair device that provides an all-arthroscopic approach, no intraarticular knots or implants, and surgeon-guided tensioning of the meniscus repair.
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Affiliation(s)
- Amanda Avila
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Scott Buzin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Dhruv S. Shankar
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | | | - Eric J. Strauss
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
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Borque KA, Laughlin MS, Webster E, Jones M, Pinheiro VH, Williams A. A Comparison of All-inside and Inside-out Meniscal Repair in Elite Athletes. Am J Sports Med 2023; 51:579-584. [PMID: 36745037 DOI: 10.1177/03635465221147058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The popularization of all-inside (AI) meniscal repair devices has led to a shift away from the historical gold standard of inside-out (IO) meniscal repair without comparative studies to support the change. PURPOSE To compare the failure rate and time to failure of AI and IO meniscal repair performed in elite athletes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review was performed of all professional and national- and international-level amateur athletes who underwent meniscal repair, with a minimum of 2-year follow-up between January 2013 and September 2019. Meniscal repair was classified as AI or IO depending on the surgical technique performed. Treatment failure was defined as patients having to undergo subsequent surgery to address a persistent meniscal tear after repair. Cox proportional hazards modeling was used to determine if meniscal repair failure rates differed by the location and technique of meniscal repair. Models were controlled for known risk factors such as age, sex, sport, and concurrent cruciate ligament reconstruction. RESULTS A total of 192 (135 lateral and 57 medial) meniscal repairs were performed in elite athletes during the study period. Overall, 41 (21%) meniscal repairs met the criteria for failure. Medial meniscal tears repaired with the AI technique failed at a significantly higher rate (18/31 [58%]) than medial meniscal tears repaired with the IO technique (6/26 [23%]) or lateral meniscal tears repaired with the AI (9/76 [12%]) or IO (8/59 [14%]) technique (P < .001). Cox proportional hazards modeling revealed that a medial meniscal tear repaired with the AI technique had an almost 8 times greater hazard of failure than a lateral meniscal tear repaired with the AI technique (P < .001). At 1 year postoperatively, 8% of lateral meniscal repairs had failed (regardless of technique), while medial meniscal tears failed at a rate of 16% with the IO technique and 42% with the AI technique. By 2 years, 53% of medial meniscal tears repaired with the AI technique had failed, and by 5 years, 63% had failed. CONCLUSION AI repair of medial meniscal tears led to a higher rate of failure than IO repair of medial or lateral meniscal tears in elite athletes. Medial meniscal repair failed at a higher rate than lateral meniscal repair.
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Affiliation(s)
| | | | | | - Mary Jones
- Fortius Clinic, London, UK.,FIFA Medical Centre of Excellence, London, UK
| | | | - Andy Williams
- Fortius Clinic, London, UK.,FIFA Medical Centre of Excellence, London, UK
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El Helou A, Gousopoulos L, Shatrov J, Hopper GP, Philippe C, Ayata M, Thaunat M, Fayard JM, Freychet B, Vieira TD, Sonnery-Cottet B. Failure Rates of Repaired Bucket-Handle Tears of the Medial Meniscus Concomitant With Anterior Cruciate Ligament Reconstruction: A Cohort Study of 253 Patients From the SANTI Study Group With a Mean Follow-up of 94 Months. Am J Sports Med 2023; 51:585-595. [PMID: 36734511 DOI: 10.1177/03635465221148497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failure rates of repaired bucket-handle medial meniscal tears (BHMMTs) concomitant with anterior cruciate ligament reconstruction (ACLR) are as high as 20%. The outcomes of posteromedial portal suture hook repair have not been compared with all-inside repair techniques for this subtype of meniscal lesion. PURPOSE/HYPOTHESIS The aim of this study was to evaluate the outcomes and failure rates of patients who underwent BHMMT repair concomitant with ACLR using an all-inside technique, suture hook + all-inside technique, or suture hook + outside-in technique. It was hypothesized that no significant differences in failure rates would be found between the groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed on patients diagnosed with a BHMMT who underwent meniscal repair during primary ACLR and had a minimum follow-up of 2 years. Patients were grouped based on the meniscal repair technique used: all-inside repair, suture hook + all-inside repair, or suture hook + outside-in repair. At the end of the study period, secondary medial meniscectomy rates were determined. RESULTS The study population comprised 253 patients who underwent repair of a BHMMT with concomitant ACLR with a mean follow-up of 94.0 ± 47.6 months. A total of 114 patients (45.1%) underwent all-inside repair, 61 patients (24.1%) underwent suture hook + all-inside repair, and 78 patients (30.8%) underwent suture hook + outside-in repair. Overall, there were 36 failures. The failure rates were 20.2%, 14.8%, and 5.1%, respectively (P = .0135). All-inside repairs were >4 times more likely to fail than suture hook + outside-in repairs (hazard ratio [HR], 4.103; 95% CI, 1.369-12.296; P = .0117). Failure was also 3 times higher (HR, 2.943; 95% CI, 1.224-7.075; P = .0159) for patients <30 years of age compared with those aged ≥30 years. An additional anterolateral ligament reconstruction (ALLR) was also found to reduce the failure rate of repaired BHMMTs concomitant with ACLR. CONCLUSION Combined suture hook + outside-in repair of BHMMTs resulted in significantly fewer failures than all other techniques. Furthermore, age <30 years and no additional ALLR were associated with higher failure rates.
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Affiliation(s)
- Abdo El Helou
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jobe Shatrov
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Graeme P Hopper
- NHS Glasgow and Clyde South Glasgow University Hospitals NHS Trust Glasgow, Glasgow, UK
| | - Corentin Philippe
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Merwane Ayata
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Benjamin Freychet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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9
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Ye Z, Wu C, Xu J, Chen J, Qiao Y, Wu X, Xie G, Dong S, Zhao J. Meniscal resection increases the risk of residual knee laxity even in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction with eight strands of hamstring autografts. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07231-9. [PMID: 36378292 DOI: 10.1007/s00167-022-07231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the midterm clinical outcomes of different meniscal surgeries in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) with eight strands of hamstring (HT8) autografts and explore the potential predictive risk factors for residual knee laxity. METHODS From 2010 to 2017, a total of 410 patients who underwent anatomic trans-tibial DB-ACLR with HT8 autografts (169 patients without meniscal surgery, 105 patients with meniscal repair, and 136 patients with meniscal resection) were included in this study. The equivalent graft diameter was introduced to make the total graft size of DB-ACLR comparable with that of single-bundle ACLR and calculated as the square root of the quadratic sum of the diameter for each bundle. Residual laxity was defined as excessive anterior tibial translation or residual pivot shift at any follow-up visit, while graft rupture was confirmed by second-look arthroscopy or magnetic resonance imaging. RESULTS The mean follow-up period was 8.3 ± 2.2 years. The mean equivalent graft diameter was 9.9 ± 0.7 mm. Graft rupture was confirmed in 16 (3.9%) patients, while residual laxity was detected in 72 (17.6%) patients (34 [25.0%] in the meniscal resection group vs. 22 [13.0%] in the no meniscal surgery group, p = 0.021). In the multivariate logistic regression analysis, high-grade preoperative knee laxity (odds ratio OR 2.04, p = 0.020), equivalent graft diameter < 9 mm (OR 3.31 compared with 9-10 mm, p = 0.012; OR 3.28 compared with ≥ 10 mm, p = 0.019), and meniscal resection (OR 1.94 compared with no meniscal surgery, p = 0.045) were associated with residual laxity. CONCLUSION During a midterm follow-up, meniscal resection increased the risk of residual knee laxity even in patients undergoing anatomic DB-ACLR with HT8 autografts. Increasing the hamstring graft diameter and preserving the menisci are important strategies for ACLR to restore knee stability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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10
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Calafiore DA, Magnussen RA, Everhart JS, DiBartola AC, Milliron EM, Kaeding CC, Flanigan DC. Smaller Iatrogenic Defects Created by Inside-Out Compared With All-Inside Meniscus Repair Devices in Human Cadaveric Model. Arthroscopy 2022; 38:3070-3079.e3. [PMID: 36344063 DOI: 10.1016/j.arthro.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE (1) To investigate the pattern and diameter of the iatrogenic defect that meniscal repair devices impose on meniscal tissue and (2) to determine whether repair-induced defect patterns or diameters differ across devices. METHODS Sixty-one fresh frozen human cadaveric menisci were used (n = 9; eliminated). All-inside devices (n = 9) included ULTRA FAST-FIX, FAST-FIX 360, Depuy Mitek 0° and 12° TRUESPAN, ConMed Sequent, Zimmer Biomet JuggerStitch, Stryker IvyAIR, Arthrex FiberStitch and Meniscal Cinch II. Inside-out needles (n = 4) included ConMed HiFi, Depuy Mitek ORTHOCORD, Arthrex-2-0 FiberWire, and Stryker SharpShooter. Following India Ink staining, implant devices were inserted into cadaveric menisci. Samples were fixed in formalin solution and imaged with a high-resolution camera. Defects were classified by qualitative evaluation. Defect and needle diameter were quantified with software assistance. Statistical analysis was performed using analysis of variance testing. RESULTS We analyzed 644 iatrogenic defects with mean defect diameter of 1.96 mm (standard deviation 0.86). For all-inside devices, defect patterns (n = 436) were 15.6% linear, 38.1% semilunar, 46.3% stellate, while inside-out devices (n = 208) were 95.7% stellate, 4.3% linear, and 0.0% semilunar. All-inside devices had mean defect diameter of 2.46 mm, while inside-out meniscus needles had mean 0.90 mm defect diameter (P < .001). FasT-FIX 360, ULTRA-FAST-FIX, and Arthrex Meniscal Cinch II induced smaller diameter defects than other all-inside devices (F = 20.2, P < .05). Strong positive correlation was found comparing outer needle diameter and mean defect diameters across all devices (R2 = 0.9447). CONCLUSIONS Needles utilized in meniscal implant systems produce the following basic defect patterns: stellate (62.3%), semilunar (25.8%), and linear (11.9%). A strong positive correlation was found between mean defect size and outer needle diameter across all devices. Inside-out double-armed flexible needles produced significantly smaller defects than all-inside devices. Of the all-inside devices, ULTRA FAST-FIX, FAST-FIX 360, and Arthrex Meniscal Cinch II produced smaller defects on average. CLINICAL RELEVANCE While the true clinical impact of these findings cannot be drawn from the present study, this investigation provides necessary context to better understand reported similarities and differences in healing rates and outcomes between inside-out and all-inside repair techniques.
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Affiliation(s)
- David A Calafiore
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio; Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Alex C DiBartola
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eric M Milliron
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christopher C Kaeding
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio; Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio; Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio; Cartilage Restoration Program, U.S.A..
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Laboudie P, Douiri A, Bouguennec N, Biset A, Graveleau N. Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:3488-3498. [PMID: 35364738 DOI: 10.1007/s00167-022-06956-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/18/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Graft failure and secondary meniscal tears are major concerns after anterior cruciate ligament (ACL) reconstruction in young athletes. The aim was to evaluate the link between ACL reconstruction with and without anterolateral ligament (ALL) reconstruction and outcomes in young patients participating in pivoting sports. METHODS This was a retrospective study of data collected prospectively. Patients less than 20 years, involved in pivoting sports and undergoing primary ACL reconstruction with a quadruple hamstring tendon (4HT) graft or 4HT graft combined with anterolateral ligament reconstruction (4HT + ALL) were included. Survival analysis was performed to identify the prognostic indicators for reoperation due to graft failure or secondary meniscal lesions. Knee laxity was assessed and patient reported outcome measures (PROMs) were collected. RESULTS A total of 203 patients (mean (± SD) age: 16.3 ± 2 years) with a mean follow-up of 4.8 ± 0.9 (range: 3.3‒6.8) years were included. There were 101 4HT and 102 4HT + ALL grafts. Graft rupture rates were 11.9% for 4HT grafts and 5.8% for 4HT + ALL grafts (n.s.). There were 9.9% secondary meniscal procedures for 4HT grafts vs. 1.9% for 4HT + ALL grafts (p = 0.02). With reoperation for graft failure or secondary meniscal lesions at final follow-up as the endpoint, survival was better in the 4HT + ALL group (91.4% vs. 77.8%, respectively; p = 0.03). Absence of ALL reconstruction (HR = 4.9 [95%CI: 1.4-17.9]; p = 0.01) and preoperative side-to-side laxity > 3 mm (HR = 3.1 [95%CI: 1.03-9.1]; p = 0.04) were independently associated with an increased rate of reoperations. Mean (± SD) side-to-side laxity was 1.3 ± 1.3 mm (range: - 2 to 5) for 4HT grafts vs. 0.9 ± 1.3 mm (range: - 6 to 4.8) for 4HT + ALL grafts (n.s.) 6 months post-surgery. The rate of return to the same sport at the same level was 42.2% for 4HT grafts vs. 52% for 4HT + ALL grafts (n.s.). There was no significant difference in subjective outcomes including PROMs between the two groups. CONCLUSION Combined ALL + ACL reconstruction reduced the rate of graft failure and secondary meniscal injury in young athletes when compared to ACL reconstruction alone. Subjective results were comparable, with a similar rate of complications. Combined reconstruction should be preferred in this young population. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pierre Laboudie
- Clinique du Sport de Bordeaux-Mérignac, 4 rue George Negrevergne Merignac, 33700, Bordeaux, France.
| | - Adil Douiri
- Clinique du Sport de Bordeaux-Mérignac, 4 rue George Negrevergne Merignac, 33700, Bordeaux, France
| | - Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 4 rue George Negrevergne Merignac, 33700, Bordeaux, France
| | - Alexandre Biset
- Clinique du Sport de Bordeaux-Mérignac, 4 rue George Negrevergne Merignac, 33700, Bordeaux, France
| | - Nicolas Graveleau
- Clinique du Sport de Bordeaux-Mérignac, 4 rue George Negrevergne Merignac, 33700, Bordeaux, France
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12
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Shi B, Stinson Z, Nault ML, Brey J, Beck J. Meniscus Repair in Pediatric Athletes. Clin Sports Med 2022; 41:749-767. [DOI: 10.1016/j.csm.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Golz AG, Mandelbaum B, Pace JL. All-Inside Meniscus Repair. Curr Rev Musculoskelet Med 2022; 15:252-258. [PMID: 35661090 DOI: 10.1007/s12178-022-09766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW The indications for partial meniscectomy are becoming increasingly limited, and recent evidence suggests that the meniscus should be preserved whenever possible. Because of its many proposed advantages, all-inside meniscus repairs are becoming increasingly common. This review discusses the indications, advantages, disadvantages, and biomechanical and clinical outcomes of all-inside meniscus repair. RECENT FINDINGS All-inside meniscus repair demonstrates equal functional outcomes, healing rates, and complications compared to inside-out repair of vertical longitudinal and bucket-handle tears with the advantages of decreased surgical time and faster post-operative recovery. In addition, return-to-sport and activity levels are high following all-inside repair regardless of whether concomitant anterior cruciate ligament reconstruction is performed. Biomechanical studies have demonstrated advantages of all-inside meniscal based repairs on radial and horizontal tears. All-inside meniscus repair compares favorably to inside-out repair of vertical longitudinal and bucket-handle tears and continues to increase in popularity. Both capsular based and meniscal based repairs can be used to repair a variety of tear patterns. While biomechanical results are encouraging, further research on the clinical outcomes of meniscal based repairs is needed to elucidate the role of these techniques in the future.
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Affiliation(s)
- A G Golz
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, CA, 90045, USA.
| | - B Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, CA, 90045, USA
| | - J L Pace
- Children's Health Andrew's Institute, Plano, TX, 75024, USA
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14
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Wang L, Jiang J, Lin H, Zhu T, Cai J, Su W, Chen J, Xu J, Li Y, Wang J, Zhang K, Zhao J. Advances in Regenerative Sports Medicine Research. Front Bioeng Biotechnol 2022; 10:908751. [PMID: 35646865 PMCID: PMC9136559 DOI: 10.3389/fbioe.2022.908751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
Regenerative sports medicine aims to address sports and aging-related conditions in the locomotor system using techniques that induce tissue regeneration. It also involves the treatment of meniscus and ligament injuries in the knee, Achilles’ tendon ruptures, rotator cuff tears, and cartilage and bone defects in various joints, as well as the regeneration of tendon–bone and cartilage–bone interfaces. There has been considerable progress in this field in recent years, resulting in promising steps toward the development of improved treatments as well as the identification of conundrums that require further targeted research. In this review the regeneration techniques currently considered optimal for each area of regenerative sports medicine have been reviewed and the time required for feasible clinical translation has been assessed. This review also provides insights into the direction of future efforts to minimize the gap between basic research and clinical applications.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
| | - Hai Lin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Tonghe Zhu
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-Coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai, China
| | - Jiangyu Cai
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yamin Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jing Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Kai Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- *Correspondence: Kai Zhang, ; Jinzhong Zhao,
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
- *Correspondence: Kai Zhang, ; Jinzhong Zhao,
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15
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Petersen W, Karpinski K, Bierke S, Müller Rath R, Häner M. A systematic review about long-term results after meniscus repair. Arch Orthop Trauma Surg 2022; 142:835-844. [PMID: 33913009 PMCID: PMC8994714 DOI: 10.1007/s00402-021-03906-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Aim of this systematic review was to analyze long-term results after meniscus refixation. METHODS A systematic literature search was carried out in various databases on studies on long-term results after meniscus refixation with a minimum follow-up of 7 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were radiological signs of osteoarthritis (OA) and clinical scores. RESULTS A total of 12 retrospective case series (level 4 evidence) were identified that reported about failure rates of more than 7 years follow-up. There was no statistical difference in the failure rates between open repair, arthroscopic inside-out with posterior incisions and arthroscopic all-inside repair with flexible non-resorbable implants. In long-term studies that examined meniscal repair in children and adolescents, failure rates were significantly higher than in studies that examined adults. Six studies have shown minor radiological degenerative changes that differ little from the opposite side. The reported clinical scores at follow-up were good to very good. CONCLUSION This systematic review demonstrates that good long-term outcomes can be obtained in patients after isolated meniscal repair and in combination with ACL reconstruction. With regard to the chondroprotective effect of meniscus repair, the long-term failure rate is acceptable. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Wolf Petersen
- Klinik Für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Grunewald, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany.
| | - Katrin Karpinski
- Klinik Für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Grunewald, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Sebastian Bierke
- Klinik Für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Grunewald, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | | | - Martin Häner
- Klinik Für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Grunewald, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
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16
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Costa GG, Grassi A, Zocco G, Graceffa A, Lauria M, Fanzone G, Zaffagnini S, Russo A. What Is the Failure Rate After Arthroscopic Repair of Bucket-Handle Meniscal Tears? A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:1742-1752. [PMID: 34161741 DOI: 10.1177/03635465211015425] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal repair has become the treatment of choice for meniscal tears, especially in the subset of bucket-handle meniscal tears (BHMTs). However, a comprehensive estimate of the corresponding failure rate is not available, thus maintaining doubts about the healing potential of these tears. Furthermore, a wide range of factors to predict high failure rates have been reported but with conflicting evidence. PURPOSE To determine the failure rate after arthroscopic repair of BHMTs as reported in the literature, compare this with the failure rate of simple meniscal tears extracted from the same studies, and analyze the influence of factors previously reported to be predictive of meniscal repair failure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic search was conducted by 2 independent reviewers using principal bibliographic databases (PubMed, Scopus, Cochrane Library, and EMBASE). After a stepwise exclusion process, 38 articles met the inclusion criteria. Failure rate data were analyzed with a random-effects proportional meta-analysis (weighted for individual study size), and forest plots were constructed to determine any statistically significant differences between BHMTs versus simple tears (longitudinal, radial, or horizontal), medial versus lateral BHMTs, isolated procedures versus repairs with concomitant anterior cruciate ligament reconstruction, and tears in red-red versus red-white zones. Moreover, a meta-regression analysis was conducted to evaluate the effect of patient age and sex, suture technique (in-out or all-inside), time from injury to surgery, mean number of stitches, and length of follow-up on failure rates. RESULTS The pooled failure rate was 14.8% (95% CI, 11.3%-18.3%; I2 = 77.2%). A total of 17 studies provided failure rates of both BHMT repairs (46/311 repairs) and simple tear repairs (54/546 repairs), demonstrating a significantly higher failure rate for BHMT repairs (risk ratio [RR] = 1.50; 95% CI, 1.05-2.15; I2 = 0%; P = .03). Medial BHMT repairs (RR = 1.94; 95% CI, 1.25-3.01; I2 = 0%; P = .003) and isolated repairs (RR = 1.77; 95% CI, 1.15-2.72; I2 = 0%; P = .009) had statistically higher risk of failure, but no statistically significant difference was found between tears in red-red versus red-white zones. Among the other factors evaluated with meta-regression, only the mean number of stitches showed a statistically significant effect on failure rates. CONCLUSION Based on the currently available literature, this systematic review provides a reasonably comprehensive analysis of failure rate after arthroscopic BHMT repair; failure is estimated to occur in 14.8% of cases. Medial tears and isolated repairs were the 2 major predictors of failure.
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Affiliation(s)
- Giuseppe Gianluca Costa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Alberto Grassi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Zocco
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Angelo Graceffa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Michele Lauria
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Giuseppe Fanzone
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
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Marigi EM, Till SE, Wasserburger JN, Reinholz AK, Krych AJ, Stuart MJ. Inside-Out Approach to Meniscus Repair: Still the Gold Standard? Curr Rev Musculoskelet Med 2022; 15:244-251. [PMID: 35489016 PMCID: PMC9276857 DOI: 10.1007/s12178-022-09764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date summary on the current literature and trends regarding use of the inside-out approach to meniscus repair. Additionally, the paper describes the authors preferred techniques for inside-out meniscus repair utilizing posteromedial and posterolateral exposures. RECENT FINDINGS There has been a substantial increase in recent publications regarding meniscus repair. However, comparisons regarding the optimal repair technique have not been conclusive. Despite the recent increase in use of all-inside devices, multiple investigations with short-to-mid-term follow-up have demonstrated similar rates of meniscus healing between inside-out and all-inside repair techniques. Similarly, current literature describes comparable failure rates of around 20%. There are variations in the profile of complications, with all-inside devices having more implant-related complications and inside-out techniques with higher neurovascular injuries. Inside-out meniscus repair is a versatile, cost-effective technique that remains the gold standard for management of most meniscus tear patterns. Through a thoughtful approach, efficient suture retrieval and repair can be performed while protecting critical neurovascular structures. All-inside meniscus repair devices have increased in popularity and surgeon access, but this technique is not without limitations and comparisons to inside-out meniscus repair demonstrates equivocal outcomes.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Jory N. Wasserburger
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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18
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Thaunat M, Foissey C, Ingale P, Haidar I, Bauwens PH, Penet A, Kacem S, Fayard JM. Survival and Risk Factor Analysis of Arthroscopic Ramp Lesion Repair During Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:637-644. [PMID: 35099318 DOI: 10.1177/03635465211068524] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of research on the management of ramp lesions associated with anterior cruciate ligament (ACL) injuries. Furthermore, there has been no report of the risk factors for failure of ramp lesion sutures, linked to either the technique used (all-inside suture implant vs suture hook through a posteromedial portal) or the type of lesion (location in the red zone or meniscocapsular junction, longitudinal extension, partial- or full-thickness tear). PURPOSE To evaluate the results of arthroscopic repair of ramp lesions and determine the risk factors associated with ramp lesion repair failure, with special focus on their subtype and the suture technique. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All patients who underwent arthroscopic ramp lesion repair in association with ACL reconstruction between November 2015 and January 2018 were evaluated retrospectively. The following parameters were studied: demographics; clinical history; clinical findings including International Knee Documentation Committee score, complications, time from injury to surgery, side-to-side laxity, and pivot shift; and surgical findings including subtype, surgical management, and type and number of sutures. Failure of the ramp lesion repair was defined at secondary arthroscopy. RESULTS Among the 248 lesions analyzed, 18 (7.3%) failures were documented. The failures occurred in 21.1% of repairs managed with the all-inside device versus 4.3% of sutures managed with the suture hook (P = .003). Among the 6 factors included in the Cox model, the only one identified as a risk factor for failure was the type of repair (P = .003), with a risk for the all-inside device that was >5-fold higher than that for the suture hook repair (corresponding hazard ratio, 5.1 [95% CI, 1.8-14.5]). No other complications involving the surgical technique or device were registered. CONCLUSION An arthroscopic all-inside technique of meniscal repair of ramp lesions appeared to be safe and effective. It provided excellent healing of the repaired meniscus, with an overall failure rate of 7.3%. The type of suture was associated with failure of the ramp lesion repair, with a significantly higher risk with the all-inside device than with suture hook repair sutures.
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Affiliation(s)
- Mathieu Thaunat
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Constant Foissey
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Pramod Ingale
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Ibrahim Haidar
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Paul Henri Bauwens
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Alexandre Penet
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Samih Kacem
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Jean-Marie Fayard
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
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Schweizer C, Hanreich C, Tscholl PM, Ristl R, Apprich S, Windhager R, Waldstein W. Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years. Knee Surg Sports Traumatol Arthrosc 2022; 30:2267-2276. [PMID: 34671817 PMCID: PMC9206598 DOI: 10.1007/s00167-021-06770-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many reports of meniscus repair outcome in short-term studies, data on the long-term outcome of meniscus repair are still scarce. The purpose of this meta-analysis was to evaluate the overall failure rate of meniscus repair with a minimum follow-up of 5 years. Additionally, possible factors influencing meniscus repair outcome were assessed. METHODS PubMed and Scopus were searched for studies of the last 20 years reporting on meniscus repair outcome with a minimum follow-up of 5 years. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search terms used for this study were ([meniscus OR meniscal] AND repair). Titles and abstracts were evaluated by two authors independently. Using meta package of R (version 3.6.2), random-effect models were performed to pool failure rates. Subgroup analyses were performed and effect estimates in form of an odds ratio with 95% CIs were established. RESULTS In total, 12 studies with 864 patients were included. Degenerative tears were excluded in two studies and one study only included traumatic meniscus tears. Other studies did not state whether the cause of meniscus tear was degenerative or traumatic. Studies reporting meniscus repair outcome on root repairs, revision anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. Revision surgery was used as failure definition in all included studies. The overall failure rate of meniscal repair at a mean follow-up of 86 months was 19.1%. There was no significant difference in meniscus repair outcome when performed in combination with anterior cruciate ligament reconstruction compared to isolated meniscus repair (18.7% vs. 28%; n.s.) or when performed on the lateral meniscus compared to the medial meniscus (19.5% vs. 24.4%; n.s.). There was no significant difference of meniscus repair outcome between vertical/longitudinal tears and bucket-handle tears (n.s.). Thirty-six percent of meniscus repair failures occur after the second postoperative year. The only significant finding was that inside-out repair results in a lower failure rate compared to all-inside repair (5.6% vs. 22.3%; p = 0.009) at 5 years. CONCLUSION The overall meniscus repair failure rate remains nineteen percent in long-term studies. The cause of failure is poorly documented, and it remains unclear whether failure of the meniscus repair itself or additional adjacent tears lead to revision surgery. Despite the given technical advantages of all-inside repair devices, this meta-analysis cannot demonstrate superior outcomes compared to inside-out or outside-in repair at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Carola Hanreich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe M. Tscholl
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Geneva, Switzerland
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
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Zheng J, Xiao Q, Wu Q, Deng H, Zhai W, Lin D. Tears of the Popliteomeniscal Fascicles of the Lateral Meniscus: An Arthroscopic Classification. Cartilage 2021; 13:256S-261S. [PMID: 33291993 PMCID: PMC8808902 DOI: 10.1177/1947603520980156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To bring forward an arthroscopic classification of the popliteomeniscal fascicles of the lateral meniscus (PFLM) tears. DESIGN Six fresh frozen knee joint samples of adult males were chosen, and the lateral meniscus at the popliteal hiatus region were measured to analyze their anatomic relationship. Patients who had received magnetic resonance imaging scan at knee joint before the surgery and diagnosed as PFLM tears by arthroscopy from April 2014 to October 2017 were selected. Data regarding the integrity of PFLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos. RESULTS The average length and thickness of the popliteal hiatus of the lateral meniscus were 2.09 ± 0.21 cm and 0.43 ± 0.08 cm, respectively. The average length of anterosuperior popliteomeniscal fascicle (APF) was 0.87 ± 0.18 cm, and the posterosuperior popliteomeniscal fascicle (PPF) was 0.72 ± 0.15 cm. A total of 36 PFLM tears in 36 patients were divided as type I (APF tear; n = 5, 13.9%), type II (PPF tear; n = 20, 55.6%), and type III (both APF and PPF tears; n = 11, 30.6%). All patients were treated with arthroscopic all-inside repair using a suture hook for the PFLM tears and follow-up for 21.1 months. All patients have done well with significantly improved Lysholm and International Knee Documentation Committee scores at the last follow-up relative to preoperative scores (P < 0.01). CONCLUSION This study suggests to possibly classify the PFLM tears for clinical practice.
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Affiliation(s)
- Jiapeng Zheng
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Qi Xiao
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Qingquan Wu
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Huiyun Deng
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Wenliang Zhai
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Dasheng Lin
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China,Dasheng Lin, Department of Orthopaedic
Surgery, Xiamen University Affiliated Southeast Hospital, Zhanghua Road 269,
Zhangzhou 363000, China.
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21
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Keyhani S, Movahedinia M, Soleymanha M, Verdonk R, Kazemi M, Qoreishy M. Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus. J Exp Orthop 2021; 8:93. [PMID: 34676494 PMCID: PMC8531177 DOI: 10.1186/s40634-021-00412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study investigates the effects of the all-inside repair of posterosuperior popliteomeniscal fascicle (PMF) on lateral meniscus stabilization using a posterior arthroscopic approach. METHODS Between 2015 and 2018, 17 patients with hypermobile lateral meniscus (HLM) underwent posterior knee arthroscopy for PMF repair. The all-inside repair was performed through posteromedial transseptal and posterolateral portals using a suture hook technique. Patients were clinically assessed based on IKDC and Lysholm scores. RESULTS Both IKDC and Lysholm scores improved significantly after an average follow-up of 3.5 years (P < 0.001). No patients underwent reoperation, and no complications associated with posterior knee arthroscopy were reported. CONCLUSION The all-inside suture hook technique using posterolateral and posteromedial transseptal portals fixes HLM with excellent IKDC and Lysholm scores. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sohrab Keyhani
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran.
| | - Mohammad Movahedinia
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
| | | | - Rene Verdonk
- Department of Orthopedics and Traumatology, Gent University, Ghent, Belgium
| | - Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
| | - Mohamad Qoreishy
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
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Bailey L, Weldon M, Kleihege J, Lauck K, Syed M, Mascarenhas R, Lowe WR. Platelet-Rich Plasma Augmentation of Meniscal Repair in the Setting of Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:3287-3292. [PMID: 34477016 DOI: 10.1177/03635465211036471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increasing incidence of anterior cruciate ligament (ACL) and meniscal injuries has led to strong interest in discovering new methods to enhance the biological healing response of these tissues. Platelet-rich plasma (PRP) contains various growth factors associated with a positive healing response, but few existing clinical studies are available to determine the risks and benefits of these therapies. PURPOSE To determine the effects of intraoperative PRP on postoperative knee function and complications at 2 years after ACL reconstruction with meniscal repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective matched case-control study was conducted between 2013 and 2017 using a single surgeon database of 1014 patients undergoing primary ACL reconstruction with concomitant meniscal repair, resulting in 324 patients (162 PRP patients and 162 control patients) who met the study criteria. Patients were matched by age, sex, graft type, and meniscal injury. The Single Assessment Numeric Evaluation (SANE) was administered at 2 years, and injury surveillance was conducted. Secondary outcomes included the time to return to activity (months), self-reported knee function (International Knee Documentation Committee [IKDC] score), functional performance testing (knee range of motion, single-leg balance, single-leg hopping, agility testing), and postoperative complications (graft failure, infection, loss of motion [requiring repeat arthroscopy for lysis of adhesions], venous thrombosis, etc). Univariate models were used for between-group comparisons, and alpha was set at .05 for all analyses. RESULTS No differences were found in SANE knee function scores between the PRP and matched-control groups at 2 years (91.6 ± 11.2 vs 92.4 ± 10.6, respectively; P = .599). Additionally, no differences were reported between groups for self-reported function (IKDC score, 87.6 ± 13.3 vs 88.1 ± 12.6; P = .952), functional performance testing (P > .05), and timing of return to activity (7.8 ± 1.9 vs 8.0 ± 1.9 months; P = .765). The PRP group demonstrated a higher rate of postoperative knee motion loss compared with the control group (13.6% vs 4.6%; P < .001). No other differences were observed in postoperative complications (P > .05). CONCLUSION The added use of intraoperative PRP did not improve self-reported knee function, functional performance, and timing of return to activity for patients undergoing ACL reconstruction with meniscal repair. Furthermore, the use of PRP may have negative consequences for regaining knee range of motion after surgery. On the basis of these data, surgeons should cautiously consider the application of PRP when planning surgery for intra-articular injuries of the knee. REGISTRATION NCT03704376 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Lane Bailey
- Department of Sports Medicine & Rehabilitation, Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA
| | - Matthew Weldon
- Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
| | - Jacquelyn Kleihege
- Department of Sports Medicine & Rehabilitation, Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA
| | - Kyle Lauck
- Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
| | - Mohammad Syed
- Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, The Winnipeg Clinic, Winnipeg, Manitoba, Canada
| | - Walter R Lowe
- Department of Sports Medicine & Rehabilitation, Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA.,Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
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Posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes. Arch Orthop Trauma Surg 2021; 141:1101-1108. [PMID: 32507947 DOI: 10.1007/s00402-020-03504-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/31/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The past 2 decades have been marked by substantial progress in our knowledge of meniscus anatomy, function, and biomechanics, and also by the shifting of the surgical treatment of meniscal lesions from traditional meniscectomy towards arthroscopic repair to get away from the early osteoarthritis associated with meniscectomy. Posterior horn injuries of the lateral meniscus (LM) have been less studied due to their lower incidence and also due to the historical technical complexity of performing a repair in the posterolateral compartment. MATERIALS AND METHODS A retrospective analysis of prospectively collected data was performed of all athletic patients who had a peripheral longitudinal tear of the lateral meniscal posterior horn and who underwent at least one repair procedure with a posterolateral approach between 2014 and 2018. The type of injury, extent of lateral meniscal tear, and characteristics of sutures placed were assessed. Clinical assessment included objective and subjective IKDC ratings. The Tegner activity level score was determined before the injury and at the last follow-up visit. Failure was defined as a need for revision surgery. All complications were documented. RESULTS The study population comprised 24 athletes with a mean follow-up of 25.2 ± 10 months. The Tegner activity level was exactly the same before the injury as after the surgery. The mean IKDC score significantly increased from 41.8 (12.2) before the surgery to 94.5 (9.1) after. There were four reoperations for failure (16.6%) that required a new suture repair. None of these revised repairs sustained a new failure as of the last follow-up. CONCLUSION Despite the long learning curve, the posterolateral approach is a safe and effective technique for longitudinal tears of the posterior horn of the LM. The results of all-inside suture repair through a posterolateral portal are comparable to other techniques.
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Özcafer R, Dırvar F, Mısır A, Dinçel YM, Büyükkuşçu MÖ, Aykut ÜS. Mid-term evaluation of clinical and functional outcomes after arthroscopic medial longitudinal and bucket-handle meniscus repair. Jt Dis Relat Surg 2021; 32:363-370. [PMID: 34145812 PMCID: PMC8343863 DOI: 10.52312/jdrs.2021.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate clinical and functional outcomes following the arthroscopic medial meniscal repair. PATIENTS AND METHODS A total of 50 patients (42 males, 8 females; mean age: 32.9±7.6 years; range, 17 to 48 years) who underwent arthroscopic repair for longitudinal and bucket-handle medial meniscal tears between March 2005 and October 2011 were retrospectively evaluated. The patients were divided into two groups as those having a longitudinal tear (patient group, n=31) and having a bucket-handle tear (control group, n=19). Preoperative and final follow-up functional outcomes were evaluated using the Lysholm Knee Score (LKS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale (TAS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS The mean follow-up was 61.7±22.8 (range, 36 to 110) months. The mean preoperative LKS, IKDC score, TAS, and KOOS scores were significantly improved at the final postoperative follow-up (p<0.05). There was no significant difference in functional outcome scores between longitudinal and bucket-handle repairs (p>0.05), and isolated repairs and concomitant meniscal repair and anterior cruciate ligament reconstruction (p>0.05). CONCLUSION Arthroscopic meniscal repair provides similar mid-term functional and clinical outcomes for longitudinal and bucket-handle medial meniscal tears. Concomitant meniscal repair does not seem to affect meniscal healing.
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Affiliation(s)
- Raşit Özcafer
- Vital Hastanesi Ortopedi ve Travmatoloji Bölümü, 34180 Bahçelievler, İstanbul, Türkiye.
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Wagala NN, Tisherman RT, Lucidi GA, Eads R, Musahl V. Meniscal problems in the ACL deficient knee: What every ACL surgeon must be able to do! OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Excellent medium-term survival of an all-inside tensionable knotted suture device justifies repair of most meniscal tears encountered during reconstructive knee ligament surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:1714-1721. [PMID: 32767078 DOI: 10.1007/s00167-020-06189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE All-inside meniscal repair devices have evolved to allow surgeons to undertake complex repairs in a timely and efficient manner. This is advantageous in active patients, where meniscus preservation is critical in preserving joint function and stability. The aim of the study was to evaluate the failure rate of all-inside meniscal repair performed in patients undergoing reconstructive ligament surgery using a particular meniscal repair device. METHODS Patients were identified using a single-site prospectively maintained patient registry. Primary outcome was failure, defined as return to surgery with documented failure of repair. Complication rates and functional scores were also recorded. Patients in whom meniscal repair failure was identified were further assessed, to identify any common features. RESULTS Over an 8-year period, 323 patients underwent meniscal repair at the time of ligament reconstruction, compared to 244 meniscectomies. Of these, 286 patients underwent repair using an all-inside suture device. One-hundred and twenty-seven repairs were to the medial meniscus only, 124 were lateral, and in 35 patients both menisci were repaired. Follow-up was to a median of 51.5 months. There were 31 (9.7%) failures reported at a median of 22 months post-operatively (IQR 13.5-41.5). Medial repair failures were seen more frequently than lateral (13.6% versus 5.6% OR 2.62 95% CI 1.17-5.88 p = 0.022). Failure of ACL reconstruction was associated with meniscal repair failure (OR 5.83 95% CI 1.55-21.95 p = 0.0039). Multi-ligament reconstruction was undertaken in 70/286 patients receiving meniscal repair and was not associated with failure (OR 1.3 95% CI 0.57-2.98 p = 0.51). Mode number of all-inside sutures used was 3 in both medial and lateral repairs (Range 1-9 lateral; 1-7 medial). CONCLUSIONS All-inside repair is a safe and versatile technique which can be used in the majority of meniscal tears encountered during ligament reconstruction with excellent mid-term success. Failure is seen more commonly in medial sided repairs and with failure of ACL reconstruction. LEVEL OF EVIDENCE IV.
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Herbst E, Neumann R, Kittl C, Raschke MJ, Fink C, Herbort M. Umfrage unter AGA-Mitgliedern zu Meniskusnahtsystemen. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Inside-out Repair of Extensive Meniscal Tears Using Posteromedial and Posterolateral Neurovascular Protective Windows. Arthrosc Tech 2021; 10:e131-e138. [PMID: 33532219 PMCID: PMC7823103 DOI: 10.1016/j.eats.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
Abstract
Three popular repair techniques for preserving the torn meniscus are the all-inside, outside-in, and inside-out techniques. Among these, the inside-out technique has shown low failure rates, and it therefore remains the gold-standard technique for repairing the torn meniscus. For extensive and chronic meniscal tears, proper use of this technique has become fundamental for knee surgeons. Nevertheless, challenges in using this technique include a higher risk of catching the neurovascular bundles on the posteromedial and posterolateral sides of the knee and difficulties in reducing and stabilizing chronically displaced meniscal fragments. In this article, the inside-out technique is revisited with an emphasis on anatomic details of how to avoid the neurovascular bundles while addressing extensive and chronic meniscal lesions.
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Turcotte JJ, Maley AD, Levermore SB, Petre BM, Redziniak DE. Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction. Knee 2021; 28:9-16. [PMID: 33278740 DOI: 10.1016/j.knee.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study examines the relationship between meniscus tear presentations and failure rates following all-inside repair in isolation and in conjunction with an anterior cruciate ligament (ACL) reconstruction. METHODS Eighty seven consecutive patients undergoing all-inside meniscal repair at a single institution from July 2016 to June 2018 were retrospectively reviewed. Details of patient presentation, tear type and location, the presence or absence of simultaneous ACL reconstruction, and surgical repair details were recorded to evaluate the relationship between patient characteristics and the primary endpoint of repair failure. RESULTS Patients were followed for an average of 2.7 ± 0.8 years. Three patients (3.4%) experienced 30-day complications including 1 deep vein thrombosis and 2 joint aspirations. Within the study time frame, 15 repairs (17.2%) failed, with 10 (11.5%) failing within one year of the initial procedure; the average time to failure was 12.3 ± 9.0 months. Patients undergoing concurrent ACL reconstruction were less likely to experience repair failure (9.7% vs. 36.0%, p = .009), while bucket-handle repairs were more likely to fail during the study period (45.0% vs. 9.0%, p = .001). These trends remained after controlling for tear location, body mass index, and number of sutures (ACL reconstruction Odds Ratio [OR]: 0.229, p = .029; Bucket-handle OR: 9.400, p = .003). CONCLUSION Our findings suggest concurrent ACL reconstruction at the time of meniscal repair is associated with increased repair survival. The all-inside technique may be successfully used across a variety of tear types and locations, although further study of its efficacy in repairing bucket-handle tears is warranted.
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Affiliation(s)
- Justin J Turcotte
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States.
| | - Alyssa D Maley
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Sandra B Levermore
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Benjamin M Petre
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Daniel E Redziniak
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
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Kimura Y, Sasaki E, Yamamoto Y, Sasaki S, Tsuda E, Ishibashi Y. Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up. Am J Sports Med 2020; 48:3525-3533. [PMID: 33125263 DOI: 10.1177/0363546520967670] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. PURPOSE To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. STUDY DESIGN Case series; Level of evidence, 4. METHODS Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). RESULTS The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection (P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. CONCLUSION Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.
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Affiliation(s)
- Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Wright RW, Huston LJ, Haas AK, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Pennings JS, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Steven J Svoboda L, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort. Am J Sports Med 2020; 48:2978-2985. [PMID: 32822238 PMCID: PMC8171059 DOI: 10.1177/0363546520948850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. PURPOSE To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. RESULTS In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. CONCLUSION Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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Smoak JB, Matthews JR, Vinod AV, Kluczynski MA, Bisson LJ. An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses. Orthop J Sports Med 2020; 8:2325967120950306. [PMID: 32953923 PMCID: PMC7485005 DOI: 10.1177/2325967120950306] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: A large number of systematic reviews and meta-analyses regarding the meniscus
have been published. Purpose: To provide a qualitative summary of the published systematic reviews and
meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the
meniscus and published between July 2009 and July 2019 was performed with
PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts,
narrative reviews, articles not written in English, commentaries, study
protocols, and topics that were not focused on the meniscus were excluded.
The most pertinent results were extracted and summarized from each
study. Results: A total of 332 articles were found, of which 142 were included. Included
articles were summarized and divided into 16 topics: epidemiology,
diagnosis, histology, biomechanics, comorbid pathology, animal models,
arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root
repairs, meniscal allograft transplantation (MAT), meniscal implants and
scaffolds, mesenchymal stem cells and growth factors, postoperative
rehabilitation, postoperative imaging assessment, patient-reported outcome
measures, and cost-effectiveness. The majority of articles focused on APM
(20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a
single source of the current evidence regarding the meniscus.
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Affiliation(s)
- Jason B Smoak
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - John R Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
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Van Genechten W, Verdonk P, Krych AJ, Saris DB. Biologic Adjuvants in Meniscus Repair: A Review of Current Translational and Clinical Evidence. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carlson Strother CR, Saris DBF, Verdonk P, Nakamura N, Krych AJ. Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kim SG, Kim SH, Baek JH, Kim JG, Jang KM, Lim HC, Bae JH. High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study. Knee Surg Relat Res 2019; 31:11. [PMID: 32660645 PMCID: PMC7219574 DOI: 10.1186/s43019-019-0009-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries. Methods We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus. Results There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025). Conclusions There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears. Level of study Level IV, retrospective case series.
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Affiliation(s)
- Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea
| | - Soo-Hyun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung-Heum Baek
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea
| | - Jae-Gyoon Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hong-Chul Lim
- Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, 421, Siheung-daero, Geumcheon-gu, Seoul, 08523, Republic of Korea
| | - Ji-Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Second-Look Arthroscopic Evaluations of Meniscal Repairs Associated With Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:2868-2877. [PMID: 31439456 DOI: 10.1016/j.arthro.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/26/2019] [Accepted: 04/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the healing status of meniscal repair performed concomitantly with anterior cruciate ligament (ACL) reconstruction with our current indication and surgical procedure based on second-look arthroscopic results. Additionally, the significance of the demographic and clinical factors that can potentially influence the healing rate was statistically assessed. METHODS Between January 2009 and January 2015, second-look was performed for patients who opted to have tibial screw removal and agreed to have concomitant arthroscopy. The healing status of the repaired meniscus was classified into 3 conditions: healed, incompletely healed, and not healed. In addition, clinical outcomes were evaluated at a minimal 1-year follow-up. The effects of patient factors on the meniscal healing rate were statistically assessed. RESULTS A total of 217 knees underwent arthroscopic meniscal repair concomitant with ACL reconstruction, while second-look was performed for 105 knees. The average period from index surgery to second-look was 15.0 months. Clinical evaluation was conducted at a mean of 17 months (12-50 months). Based on the second-look arthroscopic findings, 64 menisci, 22 menisci, and 29 menisci were categorized as healed, incompletely healed, and not healed, respectively. When the not healed condition was defined as failed repair, a Tegner activity score of 8 or more, recurrent instability, tears in the red-white to white-white zones, and time from injury to surgery of 4 months or longer were identified as clinical factors significantly correlated with failure (P < .01). CONCLUSIONS Meniscal repair in ACL reconstructed knees with expanded indications achieved a healing rate (including incomplete healing) of 75%. Clinical factors such as high sports activity level, recurrent ACL instability, poor vascularity of the repaired site, and long duration from injury to surgery were shown to impair the healing status. LEVEL OF EVIDENCE Level Ⅳ, therapeutic study, case series.
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Cruz AI, Gao B, Ganley TJ, Pennock AT, Shea KG, Beck JJ, Ellis HB. Trends in Concomitant Meniscal Surgery Among Pediatric Patients Undergoing ACL Reconstruction: An Analysis of ABOS Part II Candidates From 2000 to 2016. Orthop J Sports Med 2019; 7:2325967119869848. [PMID: 31579682 PMCID: PMC6759752 DOI: 10.1177/2325967119869848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Rates of anterior cruciate ligament (ACL) reconstruction among pediatric and adolescent patients are increasing. Limited knowledge exists about population-level rates of concomitant meniscal surgery in this age group. Purpose/Hypothesis This study sought to examine trends in concomitant meniscal procedures and describe short-term complications in pediatric and adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing and that the likelihood of performing meniscal repair or meniscectomy is associated with patient- and surgeon-specific factors. Study Design Cross-sectional study. Methods We queried ACL procedures in patients younger than 19 years reported by American Board of Orthopaedic Surgery (ABOS) part II examination candidates from 2000 to 2016. Regression models examined associations between patient and surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications. Results A total of 9766 cases were identified. Females represented 46% (n = 4468) of included cases. Mean patient age was 16.1 years (SD, 1.62 years; range, 0-18 years). The rate of concomitant ACL-meniscal procedures increased from the years 2000 to 2016 (49%-60%; P = .005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedic fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscal procedure (P = .003 and .006, respectively). Sports medicine-trained surgeons were more likely to perform meniscal repair compared with meniscectomy (+3.0%; P = .016). Younger patient age was associated with increased likelihood of undergoing meniscal repair compared with meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included infection (1.61%), arthrofibrosis (1.14%), and deep venous thrombosis or pulmonary embolism (0.11%). Sports medicine and pediatric orthopaedic fellowship training was associated with higher rates of reporting postoperative stiffness and/or arthrofibrosis. Conclusion Among ABOS part II candidates, concomitant ACL-meniscal surgery has become more common than isolated ACL procedures. Procedures involving sports medicine fellowship-trained surgeons and younger patients were associated with increased rates of meniscal repair compared with meniscectomy. Pediatric orthopaedic and sports medicine training was associated with a greater likelihood of being involved in a concomitant ACL-meniscal procedure of any kind, and surgeons with such training also reported a higher incidence of postoperative stiffness and/or arthrofibrosis in patients.
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Affiliation(s)
- Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Burke Gao
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Theodore J Ganley
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew T Pennock
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Jennifer J Beck
- Orthopaedic Institute for Children, University of California, Los Angeles, Los Angeles, California, USA
| | - Henry B Ellis
- Department of Orthopaedic Surgery, University of Texas Southwestern, Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, Texas, USA
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Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A. Evaluation of Midterm Clinical and Radiographic Outcomes of Arthroscopically Repaired Vertical Longitudinal and Bucket-Handle Lateral Meniscal Tears. Orthop J Sports Med 2019; 7:2325967119843203. [PMID: 31157282 PMCID: PMC6512156 DOI: 10.1177/2325967119843203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Lateral meniscal tears in the stable knee are rare. There are few comparative
studies evaluating functional and radiological outcomes of vertical
longitudinal and bucket-handle lateral meniscal tears. Purpose: To evaluate the midterm clinical and radiological outcomes of
arthroscopically repaired traumatic vertical longitudinal and bucket-handle
lateral meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 43 full-thickness lateral meniscal repairs, including 22 (51.2%)
for vertical longitudinal tears and 21 (48.8%) for bucket-handle tears, were
evaluated. A clinical assessment was performed according to the Barrett
criteria, and patient outcomes were measured with the Lysholm knee score,
Tegner activity scale, and overall satisfaction scale. Magnetic resonance
imaging was used as the radiological re-examination method preoperatively
and at final follow-up. A subgroup analysis examining isolated repair versus
repair with concurrent anterior cruciate ligament (ACL) reconstruction was
performed. Results: The mean follow-up period was 63.2 months (range, 24-86 months). Based on
clinical and radiological outcomes, 38 of the 43 repairs (88.3%) were
successful, and the remaining 5 (11.6%) cases were considered to be
failures. Overall, the combined results for both groups demonstrated an
improvement in the Lysholm score, Tegner score, and patient satisfaction.
There was no significant difference in the postoperative Lysholm score (91.4
vs 87.0, respectively; P = .223), Tegner score (5.4 vs 5.5,
respectively; P = .872), or patient satisfaction (7.2 vs
7.4, respectively; P = .624) between bucket-handle repair
and vertical longitudinal repair. The subgroup analysis demonstrated no
difference in outcome scores for isolated repair versus repair with
concurrent ACL reconstruction. Smoking was identified as a risk factor for
repair failure. Conclusion: Comparable clinical and radiological outcomes were obtained after vertical
longitudinal and bucket-handle lateral meniscal repairs using the all-inside
or hybrid suture technique with different suture configurations, regardless
of whether ACL reconstruction was performed. Smoking was identified as a
risk factor for failure.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopaedics and Traumatology, Ordu University School of Medicine, Ordu, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University Training and Research Hospital, Kirsehir, Turkey
| | - Soner Akkurt
- Department of Sports Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Kayseri, Turkey
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Adachi N. Editorial Commentary: The Benefits of Three-Dimensional Computed Tomography Images to Evaluate the Safety of All-Inside Meniscal Repair. Arthroscopy 2019; 35:1565-1566. [PMID: 31054731 DOI: 10.1016/j.arthro.2019.02.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
All-inside meniscal repair is a useful alternative to inside-out repair, particularly for the posterior horn of the lateral meniscus, because open approach to the complex posterolateral corner can be avoided. However, risk to the neurovascular structures is a major concern, and surgeons must be aware of portal placement, degree of penetration, patient size, and patient positioning. Imaging studies may be misleading, as they are generally obtained with the knee in extension. In the future, advanced imaging by 3-dimensional computed tomography may better allow us to preoperatively plan for a safe approach to the posterior horn of the lateral meniscus using all-inside repair techniques.
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Kaminski R, Kulinski K, Kozar-Kaminska K, Wasko MK, Langner M, Pomianowski S. Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Arthroscopy 2019; 35:1500-1508.e1. [PMID: 30902532 DOI: 10.1016/j.arthro.2018.11.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effectiveness and safety of meniscal repair in 2 groups of patients: meniscal repair with biological augmentation using a bone marrow venting procedure (BMVP) of the intercondylar notch versus meniscal repair only. METHODS This single-center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 40 patients (21 menisci in control, 23 in BMVP group) with complete vertical meniscus tears. Patients underwent all-inside and outside-in meniscal repair and a concomitant BMVP of the intercondylar notch or meniscal repair alone during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the 2 groups assessed during a second-look arthroscopy (at week 35). The secondary endpoints were changes in the International Knee Documentation Committee score, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and visual analog scale in the 2 groups at 30 months. RESULTS After 36 weeks, the meniscus healing rate was significantly higher in the BMVP-treated group than in the control group (100% vs. 76%, P = .0035). Functional outcomes were significantly better 30 months after treatment than at baseline in both groups. The International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and visual analog scale scores were significantly better in the BMVP-treated group than in the control group. No adverse events were reported during the study period. CONCLUSIONS Our blinded, prospective, randomized, controlled trial on the role of BMVP augmentation in meniscus repair, indicates that BMVP augmentation results in a significant improvement in the rate of meniscus healing (100% vs. 76%, P = .0035). The risk of adverse events related to augmentation with BMVP of the arthroscopic meniscal repair is very low. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Rafal Kaminski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland.
| | - Krzysztof Kulinski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
| | - Katarzyna Kozar-Kaminska
- Department of Medical Biology, The Stefan Cardinal Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Marcin K Wasko
- Departament of Radiology, The Medical Centre of Postgraduate Education in Warsaw, Otwock, Poland
| | - Maciej Langner
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
| | - Stanislaw Pomianowski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
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Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T, Masuda S, Ozaki T. Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Knee Surg Sports Traumatol Arthrosc 2019; 27:361-368. [PMID: 30251100 DOI: 10.1007/s00167-018-5157-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the shape and shift of the medial meniscus before and after meniscal repair concurrent with anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) at 90° of knee flexion. METHODS This study included 18 patients with ACL-deficient knees without meniscus tears (group A), 11 patients with medial meniscus tears alone (group M), and 15 patients with ACL-deficient knees complicated with medial meniscus tears (group AM). The posterior segment shape was evaluated using open MRI at 90° of knee flexion preoperatively and at 3 months postoperatively. The length, height, width, and posterior extrusion of the medial meniscus and posterior tibiofemoral distance were measured. These measurements were compared between the three groups. RESULTS On preoperative MRI, a significant difference was observed in the posterior extrusion of the medial meniscus (group A, 1.2 ± 0.5 mm; group M, 1.7 ± 0.3 mm; group AM, 4.1 ± 1.5 mm, p < 0.001). All parameters did not differ between the three groups on postoperative MRI. In addition, the posterior width and extrusion of the medial meniscus were decreased significantly after meniscal repair concurrent with ACL reconstruction. CONCLUSIONS This study demonstrated that the medial meniscus shifted posteriorly at 90° of knee flexion in ACL-deficient knees complicated with medial meniscus tears. Medial meniscal repair concurrent with ACL reconstruction improved the deformed morphology and posterior extrusion. MRI measurements of the posterior extrusion at the knee-flexed position may be clinically useful to assess the functional improvement of the medial meniscus following meniscal repair combined with ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Abstract
Anterior cruciate ligament (ACL) ruptures are commonly associated with meniscal and articular cartilage injuries, and the presence of these defects influences both short- and long-term outcomes. Multiple variables are predictive of this pathology including time from injury, age, and sex. Revision ACL reconstructions demonstrate higher rates of chondral injury than primary reconstructions. Menisci are important secondary stabilizers of the knee in the setting of ACL deficiency, and specific tear types are more consistently associated with ACL injury. Successful outcomes with multiple treatment options for meniscal tears in conjunction with ACL reconstruction have been reported. Maintaining meniscal integrity may be protective of both joint surfaces and graft stability in the long term; however, clear treatment recommendations for tear subtypes remain ill defined. High-grade chondral defects have the most consistent and potentially largest negative effect on long-term patient-reported outcomes; however, optimal treatment is also controversial with successful results demonstrated with several modalities including benign neglect.
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Ouanezar H, Blakeney WG, Latrobe C, Saithna A, Fernandes LR, Delaloye JR, Thaunat M, Sonnery-Cottet B. The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement. Knee Surg Sports Traumatol Arthrosc 2018; 26:3611-3619. [PMID: 29502169 DOI: 10.1007/s00167-018-4889-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/28/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. METHODS A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2 years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. RESULTS Two hundred patients (mean age 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1 year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. CONCLUSION Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Charles Latrobe
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Adnan Saithna
- Department of Orthopaedic Surgery, Southport and Ormskirk Hospital, Southport, UK
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Jean Romain Delaloye
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France.
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Peterson J, Paschos NK, Richmond JC. Inside-Out Meniscal Repair in the Mid One-Third of the Menisci. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients. Knee 2018; 25:1142-1150. [PMID: 30414793 DOI: 10.1016/j.knee.2018.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/15/2018] [Accepted: 09/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40 years or older. METHODS A systematic search was performed, and 225 meniscus repair outcome studies on adults were identified in the English literature. Included studies reported either individual patient data with at least one patient age ≥40 years or summary data with all patients' age ≥40 years. Failure rates were determined based on previously reported risk factors (regardless of age) including concomitant anterior cruciate ligament (ACL) reconstruction (ACLR), tear location, and tear pattern. RESULTS Meniscus repair outcomes for 148 patients from 11 studies were included (125 inside-out repairs and 23 all-inside repairs). The overall failure rate was 10% (15/148) and ranged from 0 to 23% in individual studies with more than one patient age ≥40 years. One comparative study of patients over versus under age 40 years was identified, with no difference in failure rates between groups. Most tears were peripheral tears with avascular extension (nine-percent overall failure rate) or without avascular extension (nine-percent failure rate). Among studies that reported tear pattern, overall failure rates for vertical-longitudinal or bucket handle tears were nine percent and complex and/or horizontal tears were 23%. Repairs with concomitant ACL reconstruction had a five-percent overall failure rate versus 15% in ACL intact patients. CONCLUSION Meniscus repair failure rates in patients age 40 years and older are comparable to rates quoted for younger patients. LEVEL OF EVIDENCE Level IV. Systematic review of Level III and IV studies.
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Sonnery-Cottet B, Praz C, Rosenstiel N, Blakeney WG, Ouanezar H, Kandhari V, Vieira TD, Saithna A. Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament-Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs. Am J Sports Med 2018; 46:3189-3197. [PMID: 30307740 DOI: 10.1177/0363546518800717] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ramp lesions are characterized by disruption of the peripheral meniscocapsular attachments of the posterior horn of the medial meniscus. Ramp repair performed at the time of anterior cruciate ligament reconstruction (ACLR) has been shown to improve knee biomechanics. PURPOSE The primary objectives of this study were to evaluate the incidence of and risk factors for ramp lesions among a large series of patients undergoing ACLR. Secondary objectives were to determine the reoperation rate for failure of ramp repair, defined by subsequent reoperations for partial medial meniscectomy. STUDY DESIGN Case-control study; Level of evidence, 3. Case series; Level of evidence, 4. METHODS All patients underwent transnotch posteromedial compartment evaluation of the knee during ACLR. Ramp repair was performed if a lesion was detected. Potentially important risk factors were analyzed for their association with ramp lesions. A secondary analysis of all patients who underwent ramp repair and had a minimum follow-up of 2 years was undertaken to determine the secondary partial meniscectomy rate for failed ramp repair. RESULTS The overall incidence of ramp lesions in the study population was 23.9% (769 ramp lesions among 3214 patients). Multivariate analysis demonstrated that the presence of ramp lesions was significantly associated with the following risk factors: male sex, patients aged <30 years, revision ACLR, chronic injuries, preoperative side-to-side laxity >6 mm, and concomitant lateral meniscal tears. The secondary meniscectomy rate was 10.8% at a mean follow-up of 45.6 months (range, 24.2-66.2 months). Patients who underwent ACLR + anterolateral ligament reconstruction had a >2-fold reduction in the risk of reoperation for failure of ramp repair as compared with patients who underwent isolated ACLR (hazard ratio, 0.457; 95% CI, 0.226-0.864; P = .021). CONCLUSION There is a high incidence of ramp lesions among patients undergoing ACLR. The identification of important risk factors for ramp lesions should help raise an appropriate index of suspicion and prompt posteromedial compartment evaluation. The overall secondary partial meniscectomy rate after ramp repair is 10.8%. Anterolateral ligament reconstruction appears to confer a protective effect on the ramp repair performed at the time of ACLR and results in a significant reduction in secondary meniscectomy rates.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Cesar Praz
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Nikolaus Rosenstiel
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Herve Ouanezar
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vikram Kandhari
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Adnan Saithna
- Southport and Ormskirk Hospital, Southport, UK.,School of Science and Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK
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Meniscus repairs can be saved in the event of postoperative septic arthritis. Knee Surg Sports Traumatol Arthrosc 2018; 26:2289-2296. [PMID: 29511817 DOI: 10.1007/s00167-018-4890-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/28/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus. METHODS Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee). All cases of septic arthritis following arthroscopic meniscus repair were identified. These cases were retrospectively evaluated with regard to clinical course and management, especially the number of necessary I&Ds, if eradication was achieved, and if the repaired meniscus was retained or a partial resection was necessary ('early failure'). Patients with initially maintained meniscus repairs were contacted if further meniscus surgery was performed in further follow-up ('late failure'). RESULTS 20 patients with 23 repaired menisci were included. In 65% (13 cases), a concomitant anterior cruciate ligament reconstruction was performed. A mean of 2.0 ± 1.0 (1-4) arthroscopic I&Ds were performed in the treatment of septic arthritis. In two cases, additional open surgery was performed (after outside-in sutures). Eradication was achieved in all cases. Four repaired menisci (17.4%) showed loosened fixation or substantial degradation and were consequently partially resected within treatment for septic arthritis (early failures). The follow-up rate for the 19 initially maintained menisci was 94.7% after 3.0 ± 2.2 years (median 2.8, 0.4-7.8). Three of these underwent further partial resection (13.0%). Cumulative 3-year survival rate (Kaplan-Meier method) of all repairs was 70.7% (95% CI 50.3-91.1%), and for the subgroup of initially maintained menisci 85.6% (95% CI 67.0-100.0%), respectively. CONCLUSION Septic arthritis following meniscus repair can be successfully treated with (sequential) arthroscopic I&Ds. There is a considerable rate of early failures, however, in a mid-term follow-up the failure rate of initially retained menisci is low and comparable to what we know from the literature for cases without infection. Therefore, it is generally recommended to try to save the repaired menisci in these cases. LEVEL OF EVIDENCE IV, therapeutic case series.
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Sonnery-Cottet B, Saithna A, Blakeney WG, Ouanezar H, Borade A, Daggett M, Thaunat M, Fayard JM, Delaloye JR. Anterolateral Ligament Reconstruction Protects the Repaired Medial Meniscus: A Comparative Study of 383 Anterior Cruciate Ligament Reconstructions From the SANTI Study Group With a Minimum Follow-up of 2 Years. Am J Sports Med 2018; 46:1819-1826. [PMID: 29741400 DOI: 10.1177/0363546518767659] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevalence of osteoarthritis after successful meniscal repair is significantly less than that after failed meniscal repair. PURPOSE To determine whether the addition of anterolateral ligament reconstruction (ALLR) confers a protective effect on medial meniscal repair performed at the time of anterior cruciate ligament reconstruction (ACLR). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Retrospective analysis of prospectively collected data was performed to include all patients who had undergone primary ACLR with concomitant posterior horn medial meniscal repair through a posteromedial portal between January 2013 and August 2015. ACLR autograft choice was bone-patellar tendon-bone, hamstring tendons (or quadrupled hamstring tendons), or quadrupled semitendinosus tendon graft with or without ALLR. At the end of the study period, all patients were contacted to determine if they had undergone reoperation. A Kaplan-Meier survival curve was plotted, and a Cox proportional hazards regression model was used to perform multivariate analysis. RESULTS A total of 383 patients (mean ± SD age, 27.4 ± 9.2 years) were included with a mean follow-up of 37.4 months (range, 24-54.9 months): 194 patients underwent an isolated ACLR, and 189 underwent a combined ACLR + ALLR. At final follow-up, there was no significant difference between groups in postoperative side-to-side laxity (isolated ACLR group, 0.9 ± 0.9 mm [min to max, -1 to 3]; ACLR + ALLR group, 0.8 ± 1.0 mm [min to max, -2 to 3]; P = .2120) or Lysholm score (isolated ACLR group, 93.0 [95% CI, 91.3-94.7]; ACLR + ALLR group, 93.7 [95% CI, 92.3-95.1]; P = .556). Forty-three patients (11.2%) underwent reoperation for failure of the medial meniscal repair or a new tear. The survival rates of meniscal repair at 36 months were 91.2% (95% CI, 85.4%-94.8) in the ACLR + ALLR group and 83.8% (95% CI, 77.1%-88.7%; P = .033) in the ACLR group. The probability of failure of medial meniscal repair was >2 times lower in patients with ACLR + ALLR as compared with patients with isolated ACLR (hazard ratio, 0.443; 95% CI, 0.218-0.866). No other prognosticators of meniscal repair failure were identified. CONCLUSION Combined ACLR and ALLR is associated with a significantly lower rate of failure of medial meniscal repairs when compared with those performed at the time of isolated ACLR.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Adnan Saithna
- Southport and Ormskirk Hospital, Southport, UK.,School of Science and Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Herve Ouanezar
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Amrut Borade
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jean-Romain Delaloye
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Astur DC, Pavei BS, Kaleka CC, Cohen M. Multiple hybrid sutures of bucket handle injury on the lateral and medial meniscus of the knee. BMJ Case Rep 2017; 2017:bcr-2017-222232. [PMID: 29170181 DOI: 10.1136/bcr-2017-222232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of the study is to show possibilities of several combinations of suture techniques in a rare bicompartmental bucket handle injury. According to specific injury characteristics, combined suturing techniques were used. The option for different meniscal suture techniques in the two knee compartments allowed the patient, after completing the treatment, to return to his activities with a preserved meniscus. Although meniscectomy continues to be a chosen technique in bucket handle injury, we attempted to show a case of bicompartmental meniscal suture with different techniques. In this, which could be a case of rapid resolution and quick return to activities with bicompartmental meniscectomy, we chose to preserve the menisci with more complex techniques and longer rehabilitation, believing that the preservation of this structure could be extremely valuable in the long term.
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Affiliation(s)
- Diego Costa Astur
- Departamento de Ortopedia e Traumatologia from UNIFESP/EPM, Universidade Federal de São Paulo, CETE- Centro de Traumatologia do Esporte, São Paulo, Brazil
| | | | | | - Moises Cohen
- Orthopaedic and Traumatology Department, Universidade Federal de São Paulo, CETE - Centro de Traumatologia do Esporte, São Paulo, Brazil
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Barber FA. Editorial Commentary: Feeling the Pressure! A Biomechanical Analysis of All-Inside and Inside-Out Knee Meniscus Repair. Arthroscopy 2017; 33:1849-1851. [PMID: 28969820 DOI: 10.1016/j.arthro.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/01/2017] [Indexed: 02/02/2023]
Abstract
A biomechanical, time-zero comparison found that both No. 2-0 UltraBraid inside-out sutures and FasT-Fix 360 all-inside devices used to repair a displaced bucket handle knee meniscus tear increased the contact area in deeper flexion angles (at 45°-60°) and reduced the peak contact pressure (at 45°-90°). No significance difference was observed between the inside-out and all-inside repair techniques.
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